This is a case of unilateral renal agenesis with the "lying-down" adrenal sign, seen in a G2,P1 at 36 weeks of gestation. There was oligohydramnios and the fetal biometry corresponded to only 26 weeks of growth, suggestive of severe IUGR. There was also evidence of cystic renal dysplasia on the opposite side. The bladder and the stomach bubble were barely visible. The Doppler flow parameters suggested severe uteroplacental insufficiency. The fetus died 4 days after the study. The parents declined postmortem.